七氟烷和异氟烷对鼻内镜手术鼻黏膜血流及术野影响的比较  

The effects of inhaled anesthetics on nasal mucosal blood flow and surgical field in endoscopic sinus surgery

作　　者：宋晓红[1] 李天佐[1] 丁斌[1] 王彦[1] 李小葵[1] 周兵[2] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730 [2]首都医科大学附属北京同仁医院耳鼻喉科,100730

出　　处：《北京医学》2011年第4期323-325,共3页Beijing Medical Journal

摘　　要：目的研究七氟烷及异氟烷对血流动力学、鼻腔黏膜微循环血流及术野清晰度的影响。方法 ASAⅠ～Ⅱ级择期ESS手术30例,随机分为:七氟烷组(S组,15例)以氧化亚氮-氧-七氟烷维持麻醉;异氟烷组(I组,15例)氧化亚氮-氧-异氟烷维持麻醉。两组均将BIS控制在40～50。监测记录术中平均动脉压、心率、诱导前及麻醉平稳后下鼻甲和鼻中隔黏膜血流,监测指标包括:灌注量(PU)、运动的血细胞浓度(CMBC)、血细胞平均运动速率(V)。术中出血较多时以盐酸乌拉地尔控制性降压。术野清晰度评估采用5分法,由术者在手术结束后即刻评估。结果异氟烷在降低平均动脉压(MAP)的同时增加心率(HR)(P<0.05);S组麻醉时MAP降低,HR降低(P<0.05),鼻黏膜血流的PU值和V值降低(P<0.05);平均术野清晰度评分S组为2.33分低于I组的2.8分(P<0.05)。结论与异氟烷相比,七氟烷更适于鼻内镜手术的麻醉。Objective To compare the effects inhaled sevoflurane or isoflurane on nasal mucosal blood flow and visibility of surgical field.Method Thirty Ⅰ～Ⅱ ASA cases undertaking ESS were randomly divided into two groups.Group S （n=15,sevoflurane inhalation）,Group I （n=15,isoflurane inhalation）.The BIS of the patient was 40～50 during the anesthesia.Invasive blood pressure was measured by dorsalis pedis artery catheterization and HR was recorded.The Laser-Doppler Flowmetry （LDF） was used to measure the mucosal blood flow （PU,CMBC,V） on inferior turbinate and nasal septum before and after anesthesia.Urapidil was applied to control blood pressure when necessary during the operation.The visibility of surgical field was assessed by the same surgeon immediately after the operation.Results In group S,the MAP,HR,PU and V were reduced after anesthesia.In group I,the MAP after anesthesia was decreased but the HR was increased （P0.05）,PU and V in group I were not significantly changed before and after anesthesia （P0.05）.The score of visibility of surgical field in group S was worse than that of the group I （P0.05）.Conclusion Comparing with isoflurane,sevoflurane can reduce the nasal mucosal blood flow and provide good visibility of surgical field,and is more suitable for ESS.

关 键 词：七氟烷 异氟烷 鼻黏膜血流 术野 鼻内镜手术 

分 类 号：R614[医药卫生—麻醉学]